Healthcare Provider Details

I. General information

NPI: 1073441804
Provider Name (Legal Business Name): GRAND RIVER MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 GARFIELD AVE NW
GRAND RAPIDS MI
49504-4022
US

IV. Provider business mailing address

923 GARFIELD AVE NW
GRAND RAPIDS MI
49504-4022
US

V. Phone/Fax

Practice location:
  • Phone: 313-505-7532
  • Fax: 313-505-7532
Mailing address:
  • Phone: 313-505-7532
  • Fax: 313-505-7532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL DELUCA
Title or Position: OWNER
Credential:
Phone: 313-505-7532